# PROVIDENCE HEALTH & SERVICES - WASHINGTON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PMG NW WA In Home Primary Care/Clearview
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770877227
- **Authorized official:** MR. DONALD W ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 1830 BICKFORD AVE, SUITE 211, SNOHOMISH, WA 98290-1749
- **Practice address phone:** (360) 668-1820
- **Practice address fax:** (360) 668-1825
- **Mailing address:** PO BOX 31001-4114, PASADENA, CA 91110-4114
- **Mailing address phone:** (425) 358-9786

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/01/2011
- **Last updated:** 05/14/2025